Subarachnoid hemorrhage treated with clipping: Long-term effects on employment, relationships, personality, and mood

OBJECTIVE: Only one-third of patients regain functional independence after aneurysmal subarachnoid hemorrhage (SAH). Despite this recovery, many of these patients experience psychosocial problem. We assessed the long-term effects of SAH on employment, relationships, personality, and mood. METHODS: We inclined patients who had been treated by clipping after SAH between 1985 and 2001 and who resumed independent living. Patients underwent structured interviews regarding employment, relationships and personality before and after the SAH. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale, and scores were compared between the study group and a control population. RESULTS: Six hundred and ten patients were interviewed (mean follow-up after SAH, 8.9 yr). Of the employed patients, 26% stopped working and 24% worked shorter hours or had a position with less responsibility. On average, patients returned to work 9.4 months after discharge (range, 0-96 mo). Seven percent of patients were divorced because of SAH-related problems. Fifty-nine percent of the patients reported changes in personality, with the most commonly noted changes being increased irritability (37%) or emotionality (29%). Patients with SAH had a statistically significantly higher mean depression score than the control population. Approximately 10% of the patients had a Hospital Anxiety and Depression Scale score in the range of a probable depressive or anxious state. Only 25% reported a complete recovery without psychosocial or neuro-logical problems. CONCLUSION: The long-term-psychosocial effects of SAH are considerable, even in patients who regain functional independence. Treating physicians should be aware of these long-term effects of SAH when discussing prognosis and reintegration to work after initial recovery with patients and family.